National Health Service Trusts Research Articles

Staff support for workplace trauma: a freedom of information act request survey for NHS trusts providing mental health care in England

Introduction Workplace trauma in mental health settings is defined as exposure to verbal and physical aggression, witnessing self-harm or hearing about patients’ histories of abuse. Support for workplace trauma is important for staff well-being, staff retention and ultimately patient care. Assessing the extent and adequacy of staff support for workplace trauma in mental health settings is important in identifying areas of need and good practice. Aim To determine what staff support systems are in place for workplace trauma in mental health services across England. Methods Freedom of Information Act requests were sent to all 57 National Health Service Trusts providing mental health care in England to identify policies on the support to mental health staff after traumatic incidents that they have experienced in the course of their clinical duties. Results Fifty-five Trusts provided usable data. Only half provided evidence of a psychologically informed incident response that went beyond a fact-finding exercise and only a fifth of Trusts used an established model for the response process. A small proportion of policies acknowledged workplace traumas related to staff discrimination on the basis of protected characteristics. Conclusion There is insufficient attention to supporting mental health staff with the effects of workplace trauma.

Evaluation of an acute trust Domestic Abuse Coordinator role: Impact findings and a budget impact model.

Domestic Abuse Coordinators (DACs) work strategically across National Health Service (NHS) hospital and other off-site clinical settings to support clinical staff in domestic abuse enquiry and response, and to co-lead the development and implementation of effective clinical policies and procedures for the management of domestic abuse and the support of survivors. Drawing on data from a large NHS acute trust in central London, we analyse the impact of the DAC role in increasing the rate of referrals of high-risk domestic abuse cases, and generate plausible estimates of the budget impact of the DAC role in respect of costs accrued to NHS trusts. Using eight quarters of clinical data and an interrupted time series design, we find that evidence that implementation of a DAC role is linked with an increase in the rate of high-risk referrals of between 18% and 21% per quarter, indicating improved responses to victim-survivors at highest risk of imminent harm. Under a range of reasonable assumptions, initiation of the DAC role is shown to be cost-saving to an employing acute trust. Future work should seek to quantify the direct impacts to survivor health and wellbeing of the implementation of the DAC role.

How can NHS trusts in England optimise strategies to improve the mental health and well-being of hospital doctors? The Care Under Pressure 3 (CUP3) realist evaluation study protocol

IntroductionThe growing incidence of mental ill health in doctors was a major issue in the UK and internationally, even prior to the COVID-19 pandemic. It has significant and far-reaching implications,...

Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database.

Although hospitals are key health service providers, their financial ties to drug companies are little understood. We examine non-research pharmaceutical industry payments to English National Health Service (NHS) trusts-hospital groupings providing secondary and tertiary care. We extracted data from the industry-run Disclosure UK database, analysing it descriptively and using the Jonckheere-Terpstra test to establish whether a statistically significant time trend existed in the median values of individual payments. We explained payment value and number per trust with random effects models, using selected trust characteristics as predictors. Drug companies reported paying £60,253,421 to 234 trusts, representing between 90.0% and 92.0% of all trusts in England between 2015 and 2018. As a share of payments to all healthcare organisations, the number of payments rose from 38.6% to 39.5%, but their value dropped from 33.0% to 23.6%. The number of payments for fees for service and consultancy and contributions to costs of events increased by 61.5% and 29.4%. The median payment value decreased significantly for trusts overall (from £2,250.8 to £1,758.5), including those with lower autonomy from central government; providing acute services; and from half of England's regions. The random effects model showed that acute trusts received significantly more money on average than trusts with all other service profiles; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more money than others. Trusts also received significantly less money in 2018 than in 2015. NHS trusts had extensive pharmaceutical industry ties but were losing importance as payment targets relative to other healthcare organisations. Industry payment strategies shifted towards events sponsorship, consultancies, and smaller payments. Trusts with specific service and geographical profiles were prioritised. Understanding corporate payments across the health system requires more granular disclosure data.

Increasing nursing and midwifery research leadership: impact evaluation of the National Institute for Health and Care Research Senior Nurse and Midwife Research Leader Programme at 1 year.

Although nurses and midwives make up the largest sector of the National Health Service (NHS) workforce, studies have identified a lack of knowledge, skills and confidence to engage and lead research. In 2018, the National Institute for Health and Care Research (NIHR) invested in the development of a 3-year Senior Nurse Midwife Research Leader (SNMRL) Programme aimed at developing nursing and midwifery research capacity and capability. This review was conducted at the end of year one as part of an ongoing impact evaluation of the programme. To evaluate the impact of activities undertaken by NIHR SNMRL at the end of year one of the programme. The content of anonymised end-of-year one activity, self-reported by SNMRL, was coded independently and deductively analysed by a project team using the modified Visible ImpaCT Of Research framework (VICTOR). Exemplar case studies were selected by the team to illustrate activity within domains. Working group members coded two reports independently then compared them in pairs to increase inter-rater reliability and the quality and consistency of coding. Reports from 63 of 66 SNMRL were submitted and included for analysis. Reporting reflected progress towards NIHR programme objectives. These included acting as a programme ambassador, creating a vibrant research culture, supporting staff recruitment and retention, enhancing organisational reputation and clinical academic outputs. Networking and collaboration locally, regionally and nationally were widely reported. The SNMRL cohort reported initiating multiple initiatives aimed at influencing organisational research culture, service provision and supporting nursing/midwifery engagement with research. Evaluation indicated progress to address barriers to research engagement within NHS Trusts.

Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales.

To analyze the hospitalization patterns associated with postprocedural complications among the pediatric population in England and Wales over the past two decades. This was an ecological study using hospital admission data extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Postprocedural complications related hospital admissions were identified using the 10th version of the International Statistical Classification of Diseases (ICD) system (D78, E89, H59, H95, J95, L76, M96, and N99). The rate of hospital admissions declined by 2.1% [from 8.32 (95% CI 7.75-8.88) per 100,000 persons in 1999 to 8.15 (95% CI 7.61-8.68) per 100,000 persons in 2020, p>0.05]. The primary reasons for hospital admissions associated with postprocedural complications were related to the respiratory system, genitourinary system, and ear and mastoid process, constituting 43.0%, 23.8%, and 23.0% of cases, respectively. The trend of postprocedural complications among the pediatric population has been stable in the past two decades. Continuous monitoring of the hospitalization pattern for this type of complication is important due to advancements in healthcare provision and to improve patient care and safety. Future studies are needed to examine gender-based differences related to postprocedural complications and identify important preventable risk factors.

Complications and Healthcare Costs Associated With the First Year Following Colostomy and Ileostomy Formation: A Retrospective Study.

The purpose of this study was to evaluate clinical and economic outcomes during the first year following ostomy formation. Single-center retrospective audit. The sample comprised 200 patients who underwent surgery leading to ileostomy or colostomy at a large English National Health Service (NHS) Trust. Clinical complications, medicine prescriptions, and interactions with healthcare services were reported over 12 months postsurgery, and interactions with the NHS were matched to the closest NHS unit cost to determine mean patient cost. The most common ostomy-related surgical site complications were high output (35.0%; n = 70), followed by moderate/severe peristomal skin complications (24.5%; n = 49) and bleeding (23.5%; n = 47). Ostomy management-related complications included general difficulties with ostomy management (50.0%; n = 100) and leakage-related mild peristomal skin issues (48.5%; n = 97). Clinical complication rates were highest in the first quarter following ostomy formation, except parastomal hernia, which increased in incidence over time. Ileostomy patients more frequently experienced high output, acute renal failure, and ostomy management-related complications and had increased length of inpatient admission. However, healthcare resource use was high in both groups, with a median of 13 inpatient admission days and 12 outpatient contacts overall within the first year. Mean cost per patient was £20,444.60 (US $26,018.41); 90.5% of these costs were attributed to ostomy-related factors. Patients are likely to experience at least one clinical complication following intestinal ostomy formation and have multiple interactions with the NHS. While a number of complications are more frequent in patients with ileostomies, both groups experienced considerable costs within the first year following surgery associated with ostomy management and recovery.

Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study

ObjectiveThis study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales.DesignAn ecological study.SettingA population-based study on hospitalised patients...

Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study

ObjectiveTo explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.DesignAn ecological study.SettingA...

The visibility of research within mandatory National Health Service Trust Induction programmes in England: an exploratory survey study.

Mandatory NHS Trust induction programmes are an integral part of staff orientation processes. Although research is recognised as fundamental to high-quality care, little data exist regarding whether research information is included within hospital induction. Two online national surveys were developed, with the aim of identifying Trusts which included research within their mandatory induction programme. Survey 1 was distributed to Research and Development managers across England (n = 201). Survey 2 collated information on the research content and delivery methods of induction material. The work was classified as a service evaluation and reported in accordance with CHERRIES reporting standards. Survey 1 generated 124 unique responses (61% response rate). Thirty-nine percent of Trusts (n = 48) featured information about research delivery and 24% (n = 30) about training or support to develop clinical academic careers. There was wide variation in how materials were delivered, by whom and for how long. Currently research has a limited profile within English NHS Trust mandatory induction programmes. This needs to be addressed if research is truly to be considered part of the core National Health Service business. Guidance or a modifiable template could help Trusts communicate about research delivery and clinical academic development and training to all new employees.

Commentary: The visibility of research within mandatory National Health Service Trust Induction programmes in England: an exploratory survey study.

Commentary: The visibility of research within mandatory National Health Service Trust Induction programmes in England: an exploratory survey study.

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Peer support for discharge from inpatient to community mental health care: the ENRICH research programme

Factors Considered for Outsourcing Decision of Support Services by theNational Health Service, United Kingdom

Outsourcing of support services has been in practice for decades. It was once used as a means of reducing costsand has now evolved and is being considered strategically by organisations.Not only is outsourcing prevalent in the private sector, it is also growing in the public sector including public healthcare.Outsourcing also allowsfor the implementation of new technologies, processes, and strategies that would not otherwise be available.Despite the increasing prevalence of outsourcing of support services in the National Health Service (NHS) of the United Kingdom, there is a lack of research into the factors that should be considered when evaluating the potential of outsourcing. Therefore, this researchseeks to evaluate the factors to be considered in the decision to outsource the support services in the NHS.This researchhas taken a qualitative approach with a multiple-case study concept adopted as the research strategy. Three(3)NHSTrusts have been identified with 21 respondentsfrom senior management and middle managementlevels.The main data collection was through face-to-face semi-structured interviews. The findings revealed the factors to be considered in outsourcing decisions for the NHS Trusts and are grouped into seven(7)themes. These arenamely the Environmental Factor, Financial Factor, Legal Factor, RisksFactor, Service Provider Factor, Social Factor,and Trust Factor.Thisresearch acknowledgesthat there is a need forTrusts to understand comprehensively the concept of outsourcing,and the motivation for them to go into outsourcing. In addition, the Trusts also need to acknowledge the factors that they should consider prior to deciding on outsourcing.

Investigating mortality and morbidity associated with UrINary incontinence during Older Womens Secondary Care Admissions and exploring nurses experiences of delivering related care (U-INconti): a mixed methods research protocol

IntroductionUrinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in...

Evaluating the Feasibility of a Shared-Fleet Operation in Healthcare Logistics between Public Organisations

Shared-fleet logistics involves collaboration between two or more companies to combine workloads and vehicle capacity to improve vehicle utilisation and transport efficiency and to reduce costs. This study considers the potential environmental and economic benefits of implementing a shared-fleet collaboration between two public organisations: a local government authority and a National Health Service (NHS) Trust. The research focuses on a specific case study using a historical dataset of vehicle movements, wherein the local authority’s fleet of electric courier vehicles is shared with the NHS Trust for transporting pathology samples from 78 doctors’ surgeries to a laboratory for analysis, thereby replacing the reliance on a third-party logistics provider. The benefits suggested by the results included a 17% reduction in costs, a 3% decrease in overall vehicle kilometres travelled, a 69% decrease in carbon dioxide (CO2) emissions, a 40% reduction in vehicle numbers, and a 27% reduction in total duty time. These results emphasise the considerable potential of shared-fleet operations to alleviate both environmental and economic problems in urban logistics, encouraging public sector organisations to actively pursue the implementation of collaborative solutions to enhance the efficiency of their own-account vehicles while making positive contributions to environmental sustainability.

Professional identity and role perception of Radiographers and Clinical Technologists in Nuclear Medicine – An exploratory qualitative study

IntroductionAn awareness of Professional Identity (PI), an individual's identity in relation to their professional group, and Role Perception (RP), an individual's view of their specific role, may enable safe and effective practice by providing an understanding of professional boundaries, behaviours and activities. This research aimed to explore and gain an understanding of the PI and RP of Radiographers and Clinical Technologists working as Nuclear Medicine Technologists (NMT's). Methods10 NMT's were recruited from a large National Health Service (NHS) Trust. Utilising the established methodology of Qualitative Description, data was obtained using semi-structured interviews and analysed using inductive thematic analysis. ResultsFour themes were identified: “Becoming the Unexpected” which detailed various training pathways; “Caring with Science” which described the NMT's role and defined their PI; “Same View, Different Lens” which portrayed how Radiographers and Clinical Technologists practise as team of NMT's; and “Confirmation of Professional Self” which presented how individuals view their professional status. ConclusionThe study showed that the NMT role is highly specialised, multi-faceted and patient-centred. Their professional status is based on the nature of their role and their university level education and training. They work together under the umbrella title of NMT with a dual professional identity of “provider of care” and “user of science and technology”. However, they may have an individual identity of Radiographer or Clinical Technologist that is determined by their training pathway. Implications for practiceThis research has provided valuable understanding of the PI and RP of NMT's. By highlighting the differences in the regulatory status of this workforce, an insight into the future implications in the context of national healthcare planning has been provided, highlighting potentially significant issues that may impact on the manner in which NMT's can practice.

Challenges and successes in implementing an integrated electronic patient record (HIVE) at the Manchester University National Health Service Foundation Trust, England: 1000+ legacy systems, 10 hospitals, one electronic patient record.

The Manchester University National Health Service (NHS) Foundation Trust (MFT) is one of the largest NHS Trusts in England. Historically, the Trust has had very mixed clinical record keeping, including over 1000 individual information systems. None of these health information technology systems had the full functionality of an integrated electronic patient record (EPR). MFT evolved to its current size and complexity with a vision to improve patient care in Greater Manchester by adopting a Trust-wide EPR. The EPR "Go Live" occurred in September 2022. To describe the process of EPR integration as it reflected and impacted upon MFT's health information management (HIM) teams. MFT worked through a 2-year readiness program of work. This included technical readiness, software development and migration planning. Migration of data from the approximately 1000 systems was a major undertaking, during which access to the clinical history and ongoing operational reporting needed to be maintained. Pre-implementation requirements were outlined, a change management program was implemented, and the overall implementation was managed to tight timelines. "Go Live" was achieved for the EPIC EPR product (HIVE) within MFT. Legacy systems are still in the process of being decommissioned and staff are transacting within HIVE. Significant changes in processes and reporting continue to be made, despite some challenges. The Trust delivered the single largest EPIC European "Go live." Lessons learnt continue to be identified. The impact of what the EPR means for the HIM function is described.

Clinical presentation of psychotic experiences in patients with common mental disorders attending the UK primary care improving access to psychological therapies (IAPT) Programme

BackgroundImproving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. MethodsWe used the Community Assessment of Psychic Experiences — Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. ResultsA total of 2042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (±15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. LimitationsData were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. ConclusionsPatients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress.

Count Me In: an inclusive approach towards patient recruitment for clinical research studies in the NHS

BackgroundParticipation in clinical research is associated with better patient outcomes and higher staff retention and satisfaction rates. Nevertheless, patient recruitment to mental health studies is challenging due to a reliance...

A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge.

Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems(MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. Most patient referrals (70%, 2126/3033) were marked as 'completed' by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event ratesfollowing TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44-1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57-2.45, p = 0.63]), although there remained considerable uncertainty. The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety.